Safeguards ignored in string of assisted living tragedies

Assisted living facilities were established more than a quarter-century ago in landmark legislation to provide shelter and sweeping protections to some of Florida's most vulnerable citizens: the elderly and mentally ill. But a McClatchy investigation found the safeguards once hailed as the most progressive in the nation have been ignored in a string of tragedies never before revealed to the public.

MIAMI — For more than a decade, Bruce Hall ran his assisted-living facility in Florida's Panhandle like a prison camp.

He punished his disabled residents by refusing to give them food and drugs. He threatened them with a stick. He doped them with powerful tranquilizers and, when they broke his rules, he beat them — sending at least one to the hospital.

"The conditions in the facility are not fit even for a dog," one caller told state agents.

When Florida regulators confronted Hall in 2004 over a litany of abuses at his facility, they said, he chased them from the premises while railing against government intrusion.

Under state law, regulators could have shut down Sunshine Acres Loving Care or suspended the home's license, but they did neither. Instead, they ordered the 50-year-old Hall to see a therapist for his anger and to promise not to use "any weapon or object" on his residents — allowing him to keep the doors of his Washington County facility open for five more years.

In that time, Hall went on to break nearly every provision of Florida's assisted-living law: He threw a woman to the ground, and forced her to sleep on a box spring for six days after she urinated on her covers. Though the temperature outside reached 100 degrees, he forced his residents to live without air conditioning. And during a critical overnight shift, he fell asleep on the job while a 71-year-old woman with mental illness wandered from her bed, walked out the door and drowned in a nearby pond.

In a state where tens of thousands reside in assisted living facilities, the case of Sunshine Acres represents everything that has gone wrong with homes once considered the pride of Florida.

Assisted living facilities were established more than a quarter-century ago in landmark legislation to provide shelter and sweeping protections to some of the state's most vulnerable citizens: the elderly and mentally ill.

But a McClatchy investigation found the safeguards once hailed as the most progressive in the nation have been ignored in a string of tragedies never before revealed to the public.

In Miami's Kendall suburb, a 74-year-old woman was bound for more than six hours, the restraints pulled so tightly they ripped into her skin and killed her.

In Hialeah, Fla., a 71-year-old man with mental illness died from burns after he was left in a bathtub filled with scalding water.

In Clearwater, Fla., a 75-year-old Alzheimer's patient was torn apart by an alligator after he wandered from his assisted living facility for the fourth time.

The deaths highlight critical breakdowns in a state enforcement system that has left thousands of people to fend for themselves in dangerous and decrepit conditions.

McClatchy found that the Agency for Health Care Administration, which oversees Florida's 2,850 assisted-living facilities, has failed to monitor shoddy operators, investigate dangerous practices and shut down the worst offenders.

Time and again, the agency was alerted by police and its own inspectors to caretakers depriving residents of the most basic needs — food, water and protection — but didn't take action.

McClatchy found that as the ranks of assisted-living facilities grew to make room for Florida's booming elderly population, the state failed to protect the people it was meant to serve.

For example:

_ Nearly once a month, residents die from abuse and neglect — with some caretakers even altering and forging records to conceal evidence — but law enforcement agencies almost never make arrests.

_ Homes are routinely caught using illegal restraints — including powerful tranquilizers, cages and ropes — but the state rarely punishes them.

_ State regulators could have shut down 70 homes in the past two years for a host of severe violations — including neglect and abuse by caretakers — but in the end, closed only seven.

While the number of new homes has exploded across the state — 550 in the past five years — the state has dropped critical inspections by 33 percent, allowing some of the worst facilities to stay open.

Though the state has the power to impose fines on homes that break the law, the penalties are routinely decreased, delayed or dropped altogether.

The state's lack of enforcement has prompted other government agencies to cut off funding, and in some cases refuse to send clients to live in homes the Agency for Health Care Administration won't close.

For example, the Miami-Dade County Court's mental health project won't send clients to All America ACLF, where Angel Joglar, a 71-year-old man with schizophrenia, was scalded in a bathtub after his caretaker left him alone in 2006. He died of the burns weeks later.

After Hillandale assisted living facility was caught locking residents with mental illness in a closet to punish them — along with a host of other violations — the state Agency for Persons with Disabilities cut off hundreds of thousands of dollars it was sending to the home in Pasco County.

Both facilities are still licensed by the Agency for Health Care Administration.

The agency, empowered with tough tools to enforce the law, said its goal is to get facilities to obey the rules — and imposing fines or other penalties are secondary measures.

It said pushing to revoke a home's license is a "very harsh penalty" used as a last resort. Penalties are considered based on "unique circumstances," and other actions are explored "prior to the most serious sanction of revocation," the agency said.

But McClatchy found that the agency repeatedly catches homes breaking the law but fails to act, at times with dire consequences.

The agency refuses to release the records of more than 300 questionable deaths during the past decade, citing state law. But McClatchy obtained confidential records of 70 people who died in the past eight years from the actions of their caregivers.

The records from the Department of Children & Families — another agency tasked with probing deaths — show people are routinely abused and neglected to death in assisted living facilities, but in the end, few are ever held accountable.

In an analysis of each of the deaths, including a review of police and autopsy reports, medical records and interviews with relatives, residents and employees, McClatchy found that:

_ Despite one of the toughest elder abuse laws in the country, only two caretakers were ever charged in 70 cases in which residents died from abuse or neglect since 2002. Both were sentenced to probation.

_ One caregiver was given probation in the death of a 74-year-old woman who was strapped so tightly to her bed that she suffered blood clots and died. The charges were later expunged from her record.

_ Four caretakers were caught forging and shredding medical records during death investigations — concealing key evidence. None was charged.

Records of deaths at the homes are kept secret by the state — hidden even from family members — allowing facilities to conceal the critical mistakes that took the lives of their residents.

In three cases, family members were told relatives died of natural causes, but records show their caretakers had abused and neglected them.

When the Marrone family gathered to bury the 82-year-old matriarch of the family two years ago, they believed Magdalena Marrone had succumbed to old age.

What they didn't know: Nurses at Emeritus at Crossing Pointe, in Orlando, Fla., had violated a doctor's orders and failed to give her critical heart medication for four days — and then gave her the wrong drugs on the day she died.

Marrone was found blue and frothing at the mouth in the home's activities room. Home administrators later admitted they never read her chart.

"What happened to my grandmother is just devastating," Kevin Marrone said. "We assumed as a family that it was natural."

The case is among dozens buried in the archives of state regulators — the names blacked out and the details sparse — revealing the blunders and mistakes that cost people their lives in assisted living.

During the past decade, the Department of Children & Families death cases reveal a stunning sequence of fatal mistakes made by caretakers who are supposed to protect their vulnerable wards.

In more than 40 percent of the death cases reviewed by McClatchy — 29 in all — the people who died of neglect or abuse were suffering from dementia.

For a month in 2008, workers at Living Legends Retirement Center were finding Frances Tremblay sprawled on the floor, her body covered in cuts and bruises.

Instead of taking steps to protect her, administrators at the Deerfield Beach home ignored warnings from a staff nurse that she was constantly falling.

The end came after the 11th fall.

When a Broward County sheriff's deputy showed up, the 98-year-old Tremblay was lying in a puddle of blood in a locked room, screaming for help.

At the hospital, doctors found she had two black eyes, a gash over her nose and a fractured neck.

"What they did to her was criminal," said William Dean, an attorney who represents Tremblay's family.

Though charges were never filed in the case, the details of her death emerged for the first time this year, when a Broward County jury found sweeping negligence in Tremblay's death, awarding her estate $2.39 million in one of the county's largest punitive awards ever rendered against an assisted living facility.

Even when the Agency for Health Care Administration does find problems — including people dying from abuse and medical neglect — it rarely moves to close homes, allowing the same dangerous violations to turn up again.

Though Briarwood Manor has been the target of more than 1,200 police and rescue calls in the past five years, the Broward County facility has been allowed to stay open.

The drab, stuccoed home in the heart of Lauderhill has been slapped with scores of violations by the Agency for Health Care Administration — 100 in the past five years — including an episode when a man slashed his roommate with a knife during a crack binge while the night caretaker was nowhere to be found. Twice in the past five years, the state could have revoked or suspended the home's license, but did neither.

Instead, the Agency for Health Care Administration allowed Briarwood to operate for four years while it owed massive fines that peaked at more than $370,000, with the agency eventually agreeing to reduce the amount by 74 percent in 2008.

Even after the agency's own inspectors warned their supervisors that Sunshine Acres was a dangerous facility in 2004, owner Bruce Hall was allowed to renew his license and expand the home to make room for more beds.

Hall told McClatchy that regulators were "bureaucrats" who didn't have the right to tell him he couldn't impose force on unruly residents.

"If one of them jumps on you and you got to beat the hell out of them to get them off you, then you get held responsible," he said. "I'm the damn culprit that's the bad guy in all this?"

He blamed residents and his neighbors for bringing unwarranted scrutiny to the facility.

"These mentally handicapped residents, they know the game," he said. "They will play you. They are of the system, they know the system — just like a prisoner. They know what they can get away with."

In 2007 and 2008, five employees quit their jobs, saying they were tired of the abuse at the home, state reports show.

During that time, sheriff's deputies and rescue workers were called to the home more than 400 times for, among other things, fights between residents and people suffering psychiatric breakdowns.

"It was like a damn nightmare," said Dewayne Anderson, a next-door neighbor who joined a community coalition to close the home.

After more than 115 citations from the Agency for Health Care Administration, Hall sold the home in September 2009 — still holding the mortgage in a deal that will earn him $1.1 million during the next 10 years.